Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland.
Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland.
Addict Behav. 2019 Nov;98:106049. doi: 10.1016/j.addbeh.2019.106049. Epub 2019 Jul 12.
Alcohol, cannabis and other substance use affects young people's health. Primary care physicians are encouraged to screen and provide brief interventions for substance use in this population, but implementation is often limited. Pre-consultation self-administered screening may decrease at-risk substance use and could have population-level benefits. A randomized controlled trial is planned to test this hypothesis. The present pilot study's objective was to assess the feasibility of methods for the future trial.
The parallel-group randomized controlled pilot trial was undertaken in 6 primary care practices in Geneva, Switzerland, over 2 months. 29 patients aged 15-24 years consulting for any reason were randomly assigned to intervention (substance use screening, n = 14) or control (physical activity questionnaire, n = 15) using computer-generated random number tables. Outcomes were assessed one month later by telephone questionnaire. Physicians, practice staff and outcome assessors were blinded to allocation. The primary outcomes were feasibility of procedures and acceptability to participants, primary care physicians and practice staff.
Of 16 participants reached at follow-up, 3 reported excessive substance use. Methods were acceptable to all participants, especially regarding confidentiality. Three participants were lost due to technical difficulties with the consent form. No major problems with study methods were reported in the practices. 4 practices did not meet recruitment targets.
The study procedures proved to be feasible in primary care practices and acceptable to young people who were readily available to participate. The main challenge for the future full-sized trial will be to ensure that recruitment targets can be met.
酒精、大麻和其他物质的使用会影响年轻人的健康。鼓励初级保健医生对该人群进行物质使用筛查，并提供简短干预，但实施通常受到限制。预咨询自我管理筛查可能会减少高危物质使用，并可能具有人群层面的益处。计划进行一项随机对照试验来检验这一假设。本前瞻性研究的目的是评估未来试验方法的可行性。
这项平行组随机对照试验在瑞士日内瓦的 6 个初级保健机构进行，历时 2 个月。29 名 15-24 岁因任何原因就诊的患者被随机分配至干预组（物质使用筛查，n=14）或对照组（身体活动问卷，n=15），使用计算机生成的随机数表。一个月后通过电话问卷评估结果。医生、诊所工作人员和结果评估人员对分配情况不知情。主要结局是评估程序的可行性和参与者、初级保健医生和诊所工作人员的可接受性。
在随访时联系到的 16 名参与者中，有 3 名报告了过量物质使用。所有参与者，尤其是在保密性方面，都对方法表示接受。由于同意书的技术问题，有 3 名参与者失访。诊所未报告研究方法存在重大问题。4 家诊所未达到招募目标。
研究程序在初级保健实践中被证明是可行的，并且易于招募年轻人参与。未来大规模试验的主要挑战将是确保能够达到招募目标。
